Dull pain in kidney area

Introduction Dull pain in the kidney area is another common symptom of kidney cancer. Most of them are dull pain, which is limited to the waist. The pain is often caused by the swelling of the tumor and the kidney capsule is inflated. The blood clot can also cause low back pain through the ureter. The tumor is heavier and persistent when it invades the surrounding organs and the psoas.

Cause

The cause of kidney cancer is unknown, but there are data showing that the incidence is related to smoking, antipyretic and analgesic drugs, hormones, viruses, radiation, coffee, cadmium, strontium, etc.; other occupations such as oil, leather, asbestos and other industrial workers prevalence rate high.

(a) Smoking: A large number of prospective observations have found that smoking is positively associated with kidney cancer. Relative risk factors for renal cancer (RR) = 2 in smokers, and those who smoked for more than 30 years and who smoked filterless cigarettes have an increased risk of kidney cancer.

(b) Obesity and hypertension: A prospective study published in the November 2, 2000 issue of the New England Journal of Medicine showed that high body mass index (BMI) and hypertension are associated with increased risk of kidney cancer in men. Two independent factors.

(iii) Occupation: There has been an increase in the risk of kidney cancer incidence and death among workers exposed to metal shops, newspaper printers, coke workers, dry cleaning and petrochemical workers.

(iv) Radiation: There are statistics on 26 cases of 124 cases of tumors caused by the use of a weak alpha particle radiation source, but no reports of radiation exposure and renal cancer of radiation workers and atomic bomb victims have been reported. .

(v) Genetics: There are some intra-renal kidney cancers that are found during chromosome examinations. The third pair of chromosomes in people with a high incidence of renal cancer are defective. Most familial renal cancers have an early onset age and tend to be multi-focal and bilateral. In a rare hereditary disease, hereditary canthile hamartoma (VHP), up to 28% to 45% of patients with kidney cancer.

(vi) Food and Drugs: The survey found that high intake of dairy products, animal protein, fat, low intake of fruits and vegetables are risk factors for kidney cancer. The risk that coffee may increase kidney cancer is not related to coffee consumption. In animal experiments, kidney cancer has been proven due to female hormones (estrogen), but there is no direct evidence in the human body. Abuse of antipyretic analgesics, especially those containing phenacetin, may increase the risk of renal cancer. Diuretics may also be a factor in promoting the development of kidney cancer. Through animal experiments, it was concluded that red vine grass, also known as "thousand roots", may induce kidney cancer. The Korea Food and Drug Safety Agency has requested domestic companies to stop producing red vine grass food additives.

(7) Other diseases: In patients undergoing long-term maintenance hemodialysis, cystic changes occur in the atrophic kidney (acquired cystic disease), and cases of renal cancer are found to increase. Therefore, those who have been dialysis for more than 3 years should check the kidneys every year. It has been reported that diabetic patients are more likely to develop kidney cancer. 14% of patients with kidney cancer have diabetes, which is five times more common in people with diabetes.

an examination

Related inspection

Urine routine urine inclusion body examination tumor contrast angiography

1. General examination: hematuria is an important symptom. Polycythemia occurs mostly in 3% to 4%. Progressive anemia can also occur. The total renal function of bilateral renal tumors usually does not change, and the erythrocyte sedimentation rate increases. Some patients with renal cancer have no Bone metastasis can have symptoms of hypercalcemia and increased serum calcium levels. Symptoms of renal cancer are quickly relieved after resection, and blood calcium is returned to normal. Sometimes it can progress to liver dysfunction such as resection of the tumor to restore normal.

2. X-ray angiography is the main means of diagnosing kidney cancer

(1) X-ray film: X-ray film can see the shape of the kidney is enlarged, and occasional tumor calcification is limited in the tumor or extensive flocculation can also become a calcified line around the tumor, especially young Renal cancer is more common.

(2) intravenous urography: This is a routine examination method, because it can not show the tumor that has not caused kidney and kidney sputum undeformed and it is difficult to distinguish whether the tumor is renal cell vascular smooth muscle lipoma renal cyst, so its importance must be reduced simultaneously Ultrasound or CT examination, further identification, but intravenous urography can understand the function of bilateral kidneys and the ureter and ureter and ureter and bladder, which has important reference value for diagnosis.

(3) renal angiography: renal angiography can be found in urinary tract angiography undeformed tumor kidney cancer. The existing neovascular arteriovenous fistula contrast agent pool-like aggregation (Pooling) envelope angiogenesis angiography variation sometimes kidney cancer may not be developed, such as tumor necrosis cystic arterial embolization and other renal angiography may be injected into the renal artery if necessary Normal vasoconstriction and tumor blood vessels are unresponsive. Renal artery embolization can also be performed in the case of large renal cancer selective renal angiography, which can reduce the possibility of surgical resection of hemorrhagic renal cell carcinoma and severe renal hemorrhage as a palliative treatment.

3, ultrasound scanning: is the most simple and non-invasive method of examination. As part of a routine physical examination, more than 1 cm of mass in the kidney can be found by ultrasound scanning. It is important to identify whether the tumor is a solid tumor of renal cell carcinoma. Because there may be hemorrhagic necrosis and cystic changes inside, the echo is not uniform, and the state of hypoechoic renal cancer is generally not clear. This is different from renal cyst. Intrarenal space-occupying lesions may cause fat deformation or rupture of the renal pelvis and renal sinus. Ultrasonography of renal papillary cystadenocarcinoma is similar to cysts, and may have calcified renal cancer and cysts. It is safe to puncture under ultrasound guidance when it is difficult to identify. Puncture fluid can be used for cytology and cyst cyst fluid. Clear; no tumor cells with low fat angiography can be a benign lesion when the cyst wall is smooth; if the puncture fluid is bloody, it should be thought that the tumor may be found in the extractant when the tumor cell is not smooth, the cyst wall can be diagnosed as a malignant tumor; Angiomyolipoma is a solid tumor of the kidney. The ultrasound shows that the strong echo of adipose tissue is easy to differentiate from renal cancer. In the case of renal cancer, it should also be noted whether the tumor penetrates the perirenal adipose tissue. There is no metastasis of the liver in the inferior vena cava of the large lymph node.

4, CT scan: CT has an important role in the diagnosis of renal cancer, can be found without renal pelvis and renal pelvis change and disease-free kidney cancer; can accurately determine the tumor density and can be accurately diagnosed in the outpatient CT can be statistically accurate diagnosis Sexuality: 91% of invasive renal vein, 78% of peri-renal spread, 87% of lymph node metastasis, 96% of nearby organ involvement; CT findings of renal cancer: renal parenchyma mass can also be prominent in renal parenchyma mass Or the lobulated border is clear or fuzzy. The soft tissue block with non-uniform density is >20Hu, which is usually slightly higher than the normal renal parenchyma between 30 and 50Hu. It can also be similar or slightly lower, and the internal heterogeneity is hemorrhagic necrosis or calcification. Caused by, sometimes can be expressed as cystic CT value, but the wall of the soft tissue nodules after intravenous injection of contrast agent, the normal renal parenchyma CT value of about 120Hu, tumor CT value is also increased but significantly lower than the normal renal parenchyma, making the tumor boundary More clear, if the CT value of the tumor is unchanged after the enhancement, the CT value of the cyst before and after the injection of the contrast agent may be determined as the liquid density, and then the renal cystic adenocarcinoma in the renal cell carcinoma and the renal artery embolization may be determined after the injection of the contrast agent. CT value does not increase renal angiomyolipoma due to its large amount of fat CT value is often negative, internal non-uniform enhancement, CT value increases, but still manifested as fat density eosinophils in the edge of CT clear internal density The CT value increased significantly after uniform enhancement.

Differential diagnosis

Differential diagnosis of dull pain in the kidney area:

Because kidney cancer has a variety of imaging methods, there is no difficulty in preoperative diagnosis. However, misdiagnosis and mistreatment often occur from time to time, sometimes causing irreparable errors, so attention must be paid.

1. Renal cysts: Typical renal cysts are easily differentiated from renal cancer from imaging examinations, but when there is bleeding or infection in the cyst, it is often misdiagnosed as a tumor. Some of the renal clear cell carcinomas are evenly distributed inside, showing a weak hypoechoic, which is easily misdiagnosed as a very common renal cyst during physical examination screening. Cloix reported 32 surgical findings of complex cystic masses of the kidneys and found that 41 of them were kidney cancers. For benign renal cysts with irregular wall thickening and high central density, it is difficult to use any of the above-mentioned methods for identification. It is often necessary to comprehensively analyze and judge, and if necessary, biopsy can be performed under B-guided guidance. It is not advisable to give up the follow-up or reckless surgery.

2. Renal hamartoma: also known as renal angiomyolipoma, is a relatively common benign tumor of the kidney. With the widespread development of imaging examination, it is more and more clinically seen. In the typical hamartoma, due to the presence of fat components, qualitative diagnosis can be made on B-ultrasound, CT and MRI images, which is clinically easy to distinguish from renal cell carcinoma. Renal hamartoma B-ultrasound showed a medium-strong echogenic area. CT showed a negative CT area in the mass. After the enhanced scan, it was still negative. Angiography showed that the tumor blood vessels contracted with the blood vessels of the kidney itself after injection of adrenaline. Renal cell carcinoma B-ultrasound showed moderate to low echo, the CT value of the tumor was lower than that of normal renal parenchyma, and the CT value increased after the enhanced scan, but it was not as obvious as normal kidney tissue. Angiography showed that the kidney itself vasoconstricted after injection of adrenaline, but The tumor blood vessels do not shrink, and the tumor blood vessel characteristics are more obvious.

It can be seen that the distinguishing point between renal cancer and renal hamartoma is that there is no adipose tissue in the renal cancer and adipose tissue in the hamartoma. However, in a few cases, renal cell carcinoma tissue also contains adipose tissue, which causes misdiagnosis. In addition, it is not uncommon for a hamartoma with few fat components to be misdiagnosed as kidney cancer. Of the 49 patients with hamartoma admitted to our hospital from 1984 to 1996, 11 were diagnosed with kidney cancer because of preoperative ultrasound and low echo and/or CT for moderate to high density tumors. Analysis of the causes of misdiagnosis are: some hamartomas are mainly composed of smooth muscle, less fat components; intratumoral hemorrhage, masking fat components, resulting in B-ultrasound and CT can not be discerned; tumor volume is small, due to volumetric effects, CT is difficult to measure the true tumor density. In this case, add a thin layer of CT scan, if necessary, B-guided needle cytology can help diagnose. Some authors believe that the CT features of hamartomabial hemorrhage masking adipose tissue are more significant, but less interference with B-ultrasound results.

3. Renal lymphoma: Renal lymphoma is rare but not uncommon. Dimopoulos et al reported that 6 of 210 renal tumor patients were primary renal lymphoma. Renal lymphoma is characterized by a lack of imaging, with multiple nodular or diffuse moist kidneys, which increases the shape of the kidney. The retroperitoneal lymph nodes are mostly affected. Three of the 4 patients admitted to our hospital in recent years were not diagnosed before surgery, and the other one was confirmed by preoperative biopsy.

4. Kidney yellow granuloma: a rare type of severe chronic renal parenchymal infection. Morphologically, there are two manifestations: one is diffuse, the kidney is enlarged, the shape is abnormal, the internal structure is disordered, and it is not easy to be confused with the tumor; the other is focal, and the kidney has localized substantial nodular echo. , lack of specificity, sometimes difficult to identify with tumors. However, these patients generally have symptoms of infection, the kidney area can reach a tender mass, and there are a lot of white blood cells or pus cells in the urine. As long as you look closely, the differential diagnosis is not difficult.

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